Comments on: ACP Guideline for Medication Depression Treatment

By: v.srinivasa

v.srinivasa — Wed, 04 Feb 2009 11:40:38 +0000

help me

By: Misery Around The Web | Mister Misery

Misery Around The Web | Mister Misery — Mon, 15 Dec 2008 18:28:26 +0000

[...] The American College of Physicians recently released guidelines for treating depression, and it hasn’t gone down well with psychiatrists. [...]

By: kim_johnson

kim_johnson — Thu, 27 Nov 2008 07:23:42 +0000

Some psychiatrists do offer therapy (and are in fact trained to do so). Some psychiatry programs emphasize psychotherapy, in fact. I think it is important not to generalize from this to ALL psychiatrists…

We have known for a while now that SSRI’s are mostly placebo. I’m not sure whether knowing you are being given a placebo undermines its efficacy or not… But I guess best that word doesn’t get out… Or something…

By: current health related news articles | AMD.com

current health related news articles | AMD.com — Wed, 26 Nov 2008 23:21:43 +0000

[...] ACP Guideline for Medication Depression Treatment Mental health professionals the world over and decades worth of research would beg to differ. Read the MedPage Today article: Medical News: Psychiatrists Give Mixed Reviews on ACP Antidepressant Guideline … [...]

By: Novalis

Novalis — Wed, 26 Nov 2008 14:04:55 +0000

Despite my own pecuniary interests, I would argue that PCP’s can, and must, treat a range of low-grade depressive and anxious disorders. Just as every sore knee does not require a referral to an orthopedic surgeon, not every mood complaint requires a psychiatrist or psychologist.

To be sure, many PCP’s aren’t as good at evaluating depression as they are with a sore knee, but the answer to this is better training of PCP’s, not automatic punting/referral. After all, a large number of patients just aren’t willing to see a mental health specialist (stigma, expense, inconvenience) and even if they were, there wouldn’t be enough such specialists to treat them.

Regarding medications, psychiatry has tried for decades to show that certain types of antidepressants work better for certain “types” of depression (e.g. MAOI’s for “atypical depression”). However, this hasn’t really panned out, although some seem to like to think it has because it makes our treatments seem more precise than they are.

To be sure, there are a few major things we do know (like, as the first commenter said, don’t treat bipolar depression with antidepressants alone), but otherwise antidepressants are very broad relievers of emotional distress syndromes. Educate me if I’m wrong, but I’m not aware of any conclusive research that shows specific exceptional efficacy for any one antidepressant class for any one subtype of depression.

For these reasons, I find the ACP guidelines to be realistic given the very limited state of our knowledge and our health care system.

By: Juliet

Juliet — Wed, 26 Nov 2008 13:48:28 +0000

There’s a danger to prescribing antidepressants to those Bipolar patients who present with depression rather then mania. Key questions should be asked before writing a script for any antidepressent. I think more training is needed for primary care docs in this department. I know what this is like, as I whom am Bipolar presented with depression and was given Prozac. This sent me to the moon and made me so manic I was out of control. So, I encourage all primary docs who prescribe antidepressents to do so with this in mind!